Validation of an educational comic book to guide conducts in situations of dental trauma

BACKGROUND/AIM

Childhood dental trauma poses a prevalent concern, and the limited knowledge of lay caregivers toward the needed immediate actions can adversely affect a child's well-being. This study aimed to create and validate an educational comic book for lay individuals, designed to guide immediate actions in dental trauma cases, and assess its effects toward enhancing reader knowledge.

METHODOLOGY

The four-stage study involved: (1) Literature review and script development; (2) Version 1 of the comic book creation (including illustrations, layout, and design) and Flesch Readability Index (FI) calculation; (3) Version 1 validation by expert judges, assessed by the Content Validity Index (CVI); (4) Version 1 refinement based on the judges' feedback, recalculation of FI, and a pilot test (CVI) involving lay individuals who validated the final material (Version 2). The validation process involved 67 participants, including 13 specialist judges and 54 elementary school teachers.

RESULTS

The CVI for Version 1 was calculated at 0.89 (89%), indicating a favorable level of agreement on the evaluated criteria. The FI was determined as 91.1%, indicating a high level of readability. The FI for Version 2 was 92.1% (indicating a very easy level of comprehension). The CVI calculated for the target audience after the pilot test was 0.99 (99%), denoting a substantial agreement among the participants. In assessing the level of knowledge, a significant increase was observed in the rate of correct answers after the comic book was read by lay individuals (p < 0.05), inasmuch as the percentage rose from 50.5% before to 81.2% after reading it.

CONCLUSION

The educational comic book proved valid in terms of readability, appearance, and content. Furthermore, it had a positive impact on gaining the knowledge needed to take the appropriate actions, thus making it a valuable tool for guiding the lay population in cases of dental trauma.

Size effect in observational studies in Public Oral Health: importance, calculation and interpretation

Abstract The objective of this study was to analyze the scientific literature in public oral health regarding calculation, presentation, and discussion of the effect size in observational studies. The scientific literature (2015 to 2019) was analyzed regarding: a) general information (journal and guidelines to authors, number of variables and outcomes), b) objective and consistency with sample calculation presentation; c) effect size (presentation, measure used and consistency with data discussion and conclusion). A total of 123 articles from 66 journals were analyzed. Most articles analyzed presented a single outcome (74%) and did not mention sample size calculation (69.9%). Among those who did, 70.3% showed consistency between sample calculation used and the objective. Only 3.3% of articles mentioned the term effect size and 24.4% did not consider that in the discussion of results, despite showing effect size calculation. Logistic regression was the most commonly used statistical methodology (98.4%) and Odds Ratio was the most commonly used effect size measure (94.3%), although it was not cited and discussed as an effect size measure in most studies (96.7%). It could be concluded that most researchers restrict the discussion of their results only to the statistical significance found in associations under study.

Size effect in observational studies in Public Oral Health: importance, calculation and interpretation

The objective of this study was to analyze the scientific literature in public oral health regarding calculation, presentation, and discussion of the effect size in observational studies. The scientific literature (2015 to 2019) was analyzed regarding: a) general information (journal and guidelines to authors, number of variables and outcomes), b) objective and consistency with sample calculation presentation; c) effect size (presentation, measure used and consistency with data discussion and conclusion). A total of 123 articles from 66 journals were analyzed. Most articles analyzed presented a single outcome (74%) and did not mention sample size calculation (69.9%). Among those who did, 70.3% showed consistency between sample calculation used and the objective. Only 3.3% of articles mentioned the term effect size and 24.4% did not consider that in the discussion of results, despite showing effect size calculation. Logistic regression was the most commonly used statistical methodology (98.4%) and Odds Ratio was the most commonly used effect size measure (94.3%), although it was not cited and discussed as an effect size measure in most studies (96.7%). It could be concluded that most researchers restrict the discussion of their results only to the statistical significance found in associations under study.

Burnout syndrome in higher education health professionals working in indigenous health in Brazil

Abstract The aim of this study was to investigate the prevalence of burnout syndrome in higher education health professionals working in indigenous health in Brazil, and to identify associated factors. This is an observational, analytical, and cross-sectional study. Data collection was based on the application of a questionnaire (personal profile and MBI-HSS) and included 513 professionals. The prevalence of burnout was 65%. Greater likelihood of emotional exhaustion was observed among younger professionals, who had worked in indigenous health for longer time, in the care function and with lower level of tranquility when working during the pandemic. Lower likelihood of having low personal accomplishment at work was observed among older professionals, professionals who had worked in indigenous health for shorter time, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. Greater likelihood of depersonalization was found among married professionals, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. This study contributes with an important assessment of the existence of BS predictors in health professionals working in indigenous health.

Burnout syndrome in higher education health professionals working in indigenous health in Brazil

The aim of this study was to investigate the prevalence of burnout syndrome in higher education health professionals working in indigenous health in Brazil, and to identify associated factors. This is an observational, analytical, and cross-sectional study. Data collection was based on the application of a questionnaire (personal profile and MBI-HSS) and included 513 professionals. The prevalence of burnout was 65%. Greater likelihood of emotional exhaustion was observed among younger professionals, who had worked in indigenous health for longer time, in the care function and with lower level of tranquility when working during the pandemic. Lower likelihood of having low personal accomplishment at work was observed among older professionals, professionals who had worked in indigenous health for shorter time, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. Greater likelihood of depersonalization was found among married professionals, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. This study contributes with an important assessment of the existence of BS predictors in health professionals working in indigenous health.

Seroepidemiological investigation of COVID-19: A cross-sectional study in Jundiai, São Paulo, Brazil

The dramatic increase in the number of COVID-19 cases has been a threat to global health and a challenge for health systems. Estimating the prevalence of infection in the population is essential to provide support for action planning. Within this scenario, the aim of the present study was to analyze the seroprevalence and associated factors of COVID-19 Jundiaí, São Paulo, Brazil. This cross-sectional study was conducted from June 1st to June 19th, 2020. The participants were patients with respiratory symptoms who sought Primary Care Units (UBS) (n = 1,181) and subjects recruited from randomly selected households by probability sampling (n = 3,065), as screening strategy. All participants, in both phases, were submitted to SARS-CoV-2 rapid antigen tests (IgG and IgM) and responded to a questionnaire including sociodemographic characteristics based on Behavioural Insights for COVID-19. Total seroprevalence (positive/negative) was the outcome and the independent variables were sociodemographic variables, health behavior and signs/symptoms. The chi-squared test was used for association analysis (p<0.05) and variables with p<0.20 were entered into the logistic regression model (p<0.05). A total of 1,181 subjects from the UBS and 3,065 from the selected households participated in the study. The seroprevalence was 30.8% in the UBS and 3.1% in the households. The adjusted logistic regression identified that lower educational level (OR 2.68; 95%CI 1.59-4.54), household member testing positive (OR 1.67; 95%CI 1.16-2.39), presence of anosmia (OR 3.68, 95%CI 2.56-5.28) and seeking UBS (OR 3.76; 95%CI 2.08-6.82) was risk factors to test positive for SARS-CoV-2. Estimating the seroprevalence in the population was important to know the disease extension that was higher than the notified cases. These results showed socioeconomic aspects associated with COVID-19 even adjusted by symptoms. Populational epidemiologic studies that investigate the associated factors of COVID-19 are relevant to plan strategies to control the pandemic.

Percepção de escolares e enfermeiros quanto às práticas educativas do programa saúde na escola

Objetivo: Identificar as dificuldades do enfermeiro nas ações desenvolvidas no PSE e avaliar a percepção dos alunos sobre o programa. Métodos: 6 enfermeiros e 358 alunos de escolas públicas vinculadas ao PSE do município de Parnaíba-Piauí-Brasil responderam a um questionário pré-testado, adequado ao público alvo: escolares ou profissionais. Resultados: Alunos reconheceram a atuação do enfermeiro no cenário escolar, mas a maioria relatou que não houve avaliação dos problemas de saúde, que não teve pressão arterial verificada, que não foram orientados sobre hábitos nutricionais e que nunca receberam orientações sobre vacinação. A ação com maior coerência nas respostas entre os participantes foi aferição do peso e altura (65,6%) e a de menor foi a avaliação da visão (15,4%). Conclusão: Os enfermeiros destacam que o excesso de atribuições na UBS, a ausência de envolvimento das escolas e a falta de articulação intersetorial são os principais problemas para a boa execução do PSE.

Satisfaction of users of Psychosocial Care Centers

Objective:

evaluate the satisfaction of users with the care provided at the Psychosocial Care Centers and its association with clinical and sociodemographic factors.

Method:

this cross-sectional study was conducted with 55 users from 5 Psychosocial Care Centers. The sociodemographic and clinical characteristics were obtained through an individual structured interview. The abbreviated version of the Mental Health Services Satisfaction Scale (SATIS-BR) was used for data collection.

Results:

were descriptively analyzed and simple and multiple logistic regression models were adjusted for analysis of associations, estimating the gross and adjusted odds ratio, with the respective confidence intervals of 95%. Results: the age average of the sample was 40.1 (±12.4) years and the degree of satisfaction average was 4.56 (±0.45). Users with less education (primary school) had 5 times more chance of having less satisfaction (p<0.05). Users with frequency of intensive monitoring were 5 times more likely to have less satisfaction than users who receive monthly monitoring (p<0.05).

Conclusion:

the majority of users are satisfied with the service and factors such as low education and higher frequency of monitoring influenced the satisfaction.

Notification of cases of HIV/AIDS among the elderly in the state of Ceará: the historical sequence between 2005 and 2014

Abstract Objective: to describe the historical sequence and characteristics of reported cases of HIV/AIDS among the elderly in the state of Ceará from 2005 to 2014. Method: a descriptive study was carried out, based on the Ministry of Health database, available in SINAN (Disease Cases Notification Information System) from January 2005 to December 2014. The variables studied were: gender, race, schooling, marital status and exposure category. Result: a total of 10,299 new cases were reported in the state, 1.5% (151) of which related to the elderly. The majority of those affected lived in Fortaleza (85.6%), were aged between 60 and 69 years (86.8%), were male (60.9%), brown (61.6%), had a level of schooling below unfinished elementary (42%), were heterosexual (85.4%) and had a marital status of married (29.3%). The proportion of male/female cases peaked in 2005 (5.5: 1) and declined thereafter reaching an average value of 0.8: 1 in the period between 2008 and 2011, then increased again, reaching 3.3: 1 in 2014. The highest coefficients were observed in the groups with lower schooling. Conclusion: according to the notifications during the period evaluated, AIDS among the elderly showed a tendency of growth among men, aged between 60 and 69 years old, who were heterosexual, less educated and married. This justifies the strengthening of specific strategies aimed at this population with the objective of tackling the disease.

Factors associated with Brazilian adolescents' satisfaction with oral health

OBJECTIVE

To identify the sociodemographic, clinical and self-reported indicators of oral health associated with Brazilian adolescents' satisfaction with oral health.

METHODS

Secondary data were used following the examination of 4,231 adolescents, aged 15 to 19 years, participating in a national oral health survey (SBBrasil 2010). The independent variables were grouped into demographics, predisposition/facilitation, oral health conditions and perceived dental treatment need. Satisfaction with oral health was considered the dependent variable. Ordinal logistic (multiple) regression models tested the variables in sequence (hierarchical), as per the conceptual model, assuming p≤0.05 as the criterion for remaining in the model (Wald test). Adjustment of the model was evaluated with the Akaike information criterion (AIC) and -2 Log L.

RESULTS

Participants with perceived treatment need (OR=2.36, 95% CI = 2.14-2.61), toothache (OR=1.18, 1.10-1.28), presence of oral impacts on daily performance (OIDP) (OR= 1.55, 1.44-1.68), severe and very severe dental aesthetic index (DAI) (OR=1.17, 1.08-1.27), were female (OR=1.16, 1.10-1.23), were of black/brown ethnicity (OR=1.10, 1.04-1.17), and had caries in anterior (OR=1.20, 1.08-1.32) and posterior teeth (OR=1.22, 1.13-1.32) presented lower satisfaction with oral health.

CONCLUSION

Satisfaction with oral health in Brazilian adolescents is linked to a multidimensional structure of factors that include demographic aspects, such as gender and ethnic group, self-perception aspects, such as perceived treatment need and oral health impact on daily activities, and clinical aspects, such as the presence of toothache, severe malocclusion and caries in anterior and posterior teeth.

Violence against children and adolescents: profile and tendencies resulting from Law 13.010

ABSTRACT Objective: Describing the profile of reported violence against children and adolescents and draw an essay on the initial effects of Law 13.010 on report patterns. Method: Analytic study of reported cases on SINAN - Information System on Reportable Harms (from 2013 to 2015) of violence to individuals under 19, in 53 cities of Minas Gerais. Results: 1,481 cases were reported, 49.2% before and 50.8% after Law 13.010 came to force (p = 0.5501). There was a 7% decrease on female reports and a 27.2% in male reports (p = 0.0055). It was noticed a change in report patterns (p = 0.0023), with a 130.7% increase to neglect/abandonment reports and a 33% decrease to sexual abuse report. Higher rates of violence from the parents happens at the 1 to 9-year-old age group (p < 0.0001). Conclusion: Main victims were women, individuals from 15 to 19 years, with aggression happening within the household; after Law 13.010, changes to patterns of victim and offender profiles and of kind of violence were noticed.

Individual factors associated to malocclusion in adolescents

The study aimed to identify the severity of malocclusions and associated factors among Brazilian adolescents. Data from 5,445 adolescents participating in the Brazilian Oral Health Survey (SBBrasil 2010) were evaluated, of which 4,276 were included in the study based on the inclusion criteria. The dependent variable was severe and very severe malocclusion, according to the Dental Aesthetic Index (DAI > 30). The independent variables were place of residence, macro-region, self-reported ethnicity, income, gender, schooling, access to dental care, untreated caries and front and back teeth loss due to caries. A hierarchical multiple logistical regression analysis was performed, considering the complex cluster sampling plan. Prevalence of severe/very severe malocclusions was 17.5%. After adjustments, black/brown ethnicity group (OR = 1.59, 95% CI: 1.09-2.34), lower household income (OR = 0.67, 95% CI: 0.55-0-82), front (OR = 2.32, 95% CI: 1.14-4.76) and back teeth (OR = 1.45, 95% CI: 1.14-1.84) loss due to caries were associated with the outcome. Therefore, we conclude that black/brown ethnicity, lower household income and greater number of front and back teeth loss due to caries increased the odds for severe/very severe malocclusion.

Infection prevention and control in dental surgeries in the Pará state prison system in Brazil

Prison populations have higher levels of bloodborne viruses with consequently higher risks of cross-infection. This study assessed infection prevention and occupational hazards in prison dental surgeries in the Brazilian state of Pará. Investigations were undertaken by a single examiner in 11 prison clinics. Manual washing of instruments with no detergents and dry heat sterilization were the main instrument decontamination methods used. Most surgeries had insufficient instruments for daily clinical work requirements. Half of dentists interviewed worked single-handed with no documented policies or health and safety procedures.

Physical Examination, Doppler Ultrasound and Colour Flow Duplex Scanning: Guides to Therapy for Primary Varicose Veins

Objective:

To compare physical examination (PE) and continuous-wave hand-held Doppler (CWD) examination with colour flow duplex scanning as a gold standard for greater saphenous vein (GSV) reflux.

Design:

Prospective performance of PE and CWD by two clinical examiners and subsequent duplex scanning by two vascular laboratory technicians unaware of the results of the PE and CWD examinations. Tapes were then reviewed; results of the duplex scanning were compared with physical and CWD findings.

Patients:

Thirty-one women and nine men, aged 27–64 years, with symptomatic class I primary varicosities in distribution of the GSV. Eighty limbs were evaluated Prospectively in 40 consecutive patients, including 22 limbs in 14 patients with a history of prior GSV stripping.

Interventions:

GSV ligation and stripping in 50 limbs when duplex demonstrated saphenofemoral or truncal reflux; 30 limbs were treated by stab avulsion, cluster excision and sclerotherapy.

Main outcome measures:

Demonstration of saphenofemoral reflux by duplex was confirmed by operative findings. Sensitivity, specificity and positive and negative predictive values of PE and CWD were calculated in comparison to duplex scans.

Results:

For PE, sensitivity ad specificity were 48% and 73%; positive predictive and negative predictive values were 75% and 46%. For CWD, sensitivity and specificity were 48% and 83%; positive predictive and negative predictive values were 83% and 44%. CWD was falsely positive for saphenofemoral reflux in 10 instances. The GSV was spared in these 10 limbs and in 20 other limbs based on negative colour flow duplex examinations. At 12–18 months clinical results were similar in 50 limbs treated by ligation and GSV stripping as compared with 30 treated by stab avulsion, cluster and sclerotherapy.

Conclusion:

Sensitivity and negative predictive values for PE and CWD were low while specificity and postitive predictive values were high. CWD false postitives were due to insonation of veins close to the bulb or upper superficial femoral vein reflux subsequently detected by duplex scans. Colour flow duplex scanning is recommended prior to intervention for primary saphenous varicosities; exceptions occur in slender subjects where PE and CWD are more specific and predictive for reflux.

Assessment of the Influence of Meal Type on Fluoride Absorption due to Ingestion of professionally Applied Gels

AIMS

The aim of this study is to assess the influence of eating, prior to application of professionally used gels, on the rate of fluoride absorption due to the ingestion of 1.23% acidulated phosphate fluoride (APF).

MATERIALS AND METHODS

After fasting for 12 hours, 16 adult volunteers (> 65 kg) ingested two types of meal: Breakfast (n = 8) and Lunch (n = 8). Accidental ingestion of fluoride gel used in molding trays was simulated (12,300 ppm; 61.5 mg F; pH = 4.65) 15 minutes after eating. After ingestion of the fluoride solution, 3 mL of venous blood were collected at the following times: Zero (before ingestion) and 15, 30, 45 minutes, 1, 2, and 3 hours. Fluoride concentrations in blood plasma were determined using an ion selective electrode.

RESULTS

With the exception of time 0 (p > 0.05), the average blood plasma concentration of the breakfast group (BG) (0.34 ± 0.04 mg/L) was higher than that of the lunch group (LG) (0.24 ± 0.03 mg/L), with the moment of peak concentration being 2 hours after ingestion for both groups (BG = 0.4 mg/L; LG = 0.28 mg/L).

CONCLUSION

Results reinforce the idea that eating before undergoing professional application of fluoride is a factor of extreme importance regarding its safety, and that the time following a patient's heaviest meal should be the time of choice for planning clinical care.

CLINICAL SIGNIFICANCE

Our results should be considered when planning collective action that involves the application of the gel on children in a school environment, thus ensuring the procedure's safety.

Diagnostic reliability of a simplified epidemiologic tool to detect high-risk overjet for dental trauma

Objective: To evaluate the diagnostic reliability of a simplified tool to detect high-risk overjet for dental trauma. Material and Methods: The study population was composed of 131 volunteers divided into two groups according to the overjet measurement in terms of risk for traumatic dental injury (GRAB: risk absent and GRPR: risk present). The distance between the most prominent labial surface and its corresponding counterpart was measured using both the conventional (WHO, 1997) and the simplified tool. The measurements were taken independently and on separate occasions by two previously calibrated dental surgeons (Kappa=0.86). The gold standard method, as recommended by the WHO (1997), was performed by an external examiner. The simplified method, based on pencil-marked wooden tongue depressors was carried out in a blind manner by the other examiner. Sensitivity, specificity, positive and negative predictive values were calculated for the classification of risk for dental trauma in terms of overjet using the simplified method and compared to the conventional method. Results: The results revealed high values for sensitivity (S=1), specificity (E=0.93), positive (PPV=0.95) and negative predictive value (NPV=1). Conclusion: The examination using the simplified tool was reliable in identifying high-risk overjet, thus offering an alternative to the conventional examination.

Evaluation of scientific production in the field of Dentistry in Public Health from 1999 to 2009

Introduction: Studies that analyze scientific production are essential to guide researchers. Aim: The purpose of this study was to analyze the profile of scientific production in the field of Dentistry in Public Health, by means of the abstracts published in the Annals of Sociedade Brasileira de Pesquisa Odontológica in the period from 1999 to 2009. Material and method: First, the reading of all the 22388 abstracts published in the annals of the Sociedade Brasileira de Pesquisa Odontológica from 1999 to 2009 was undertaken. The sample was 3061 abstract belonging to Public Health area. Result: There was growing participation of studies on Dentistry in Public Health with 113 studies having been inscribed in 1999 and 441 in 2009. There was a predominance of scientific studies in comparison with systematic reviews, meta-analyses, or case reports. In the classification of general nature of the research, 71.28% concerned studies with human beings. The greatest weight in the total number of researches with humans was in 2002, contributing with 79.79% of the total. With regard to the area of thematic domain, it was verified that studies involving Epidemiology were more frequent in all the years. When analyzing the institutional origin of studies, it was verified that in all the studied years, the public universities were responsible for the majority of scientific publications, 75.6% (n=2315). Conclusion: The studies on Dentistry in Public Health have grown significantly in the studied period of ten years. There was predominance of Epidemiological studies, and those of the in vivo and scientific research type.

Risk indicators of gingivitis in 5-year-old Brazilian children

PURPOSE

To identify the risk indicators of gingivitis among socioeconomic, clinical and gender variables in 5-year-old children attending preschools in Piracicaba, Brazil, in 2005.

MATERIALS AND METHODS

The sample consisted of 728 subjects attending 22 public (n = 428) and 18 private (n = 300) preschools. A previously calibrated examiner performed the clinical examination in an outdoor setting, under natural light, using a dental mirror, Community Periodontal Index probe and air-drying. Gingival status was measured using the gingival alteration index for 5-year-olds according to the national survey carried out in 2002 in Brazil (Health Ministry of Brazil, 2004). Socioeconomic variables (monthly family income, number of people living in the household, parents' educational level, home ownership and car ownership) were collected by means of a parental semi-structured questionnaire.

RESULTS

The prevalence of gingivitis was 16.6%. Monthly family income (p < 0.0001), father's education (p < 0.0007), mother's education (p = 0.0004), type of school (p < 0.0001), car ownership (p = 0.0854), gender (p = 0.0087), initial lesion (p < 0.0001), dental caries (p = 0.0008), crowding (p = 0.0054) and spacing (p = 0.0019) were associated with gingival bleeding at p < 0.15 and were selected for the regression analysis. By means of multiple logistic regression analyses, monthly family income of up to 4 Brazilian minimum wages, presence of initial lesion, presence of crowding and male gender were found to be risk indicators of gingivitis.

CONCLUSION

The prevalence of gingivitis in 5-year-old preschool children in Piracicaba was 16.6%. Also, family income of up to 4 minimum wages, male gender, the presence of initial caries lesion and crowding were risk indicators of gingivitis.

Effect of Different Diagnostic Thresholds on Dental Caries Calibration

OBJECTIVES

(a) To analyze the intra- and inter-examiner reproducibility (reliability) of a calibration trial, at different diagnostic thresholds of dental caries; (b) to verify the accuracy (benchmark validity) though sensitivity (S), specificity (SP), positive (PPV) and negative predictive (NPV) values.

PARTICIPANTS

A group of dental examiners (n=11), who had previous experience in epidemiological surveys and six to seven-year-old children. Children were selected according to the dmft and dental caries activity.

METHODS

Theoretical and clinical training and calibration exercises were arranged for a total of 28 hours. WHO criteria including the active initial lesions (IL) were used.

MAIN OUTCOME MEASURES

WHO and WHO+IL diagnostic thresholds according to tooth and dental surface.

RESULTS

Excellent mean results of intra and inter-examiner Kappa values were found for both diagnostic thresholds, according to tooth and surface, during the calibration phase. The most relevant errors were related to IL diagnosis and to the first permanent molars. When assessed against a benchmark examiner, moderate to high validity values were observed (0.71-1.00), with some loss mainly for sensitivity and positive predictive value, when including IL.

CONCLUSION

It was possible and feasible to use the proposed methodology of this study in epidemiological surveys, even with the inclusion of IL. However, further examiner calibration studies are still needed in order to improve and establish a methodology of calibration with this new diagnostic threshold.

Comparação entre medidas de reprodutibilidade para a calibração em levantamentos epidemiológicos da cárie dentária

Comparar três medidas (kappa, porcentagem geral de concordância e índice dice) utilizadas para se determinar a reprodutibilidade do diagnóstico da cárie em levantamentos epidemiológicos, sob diferentes níveis de detecção da doença. Onze examinadores com experiência prévia em levantamentos epidemiológicos foram submetidos a um processo teórico-clínico de calibração. Dois níveis de detecção da cárie foram adotados: Organização Mundial da Saúde (OMS) e OMS com inclusão de lesões iniciais em esmalte (OMS + LI). Os exames foram realizados em 23 crianças de 6-7 anos de idade com e sem atividade da doença. A análise dos dados foi realizada mediante dois limiares: OMS e OMS + LI. Valores médios dos índices kappa, porcentagem geral de concordância e dice foram considerados altos (>0,90), à exceção do índice dice para o limiar OMS + LI (0,69). O kappa, por ser um índice de concordância ajustado, pode ser considerado como instrumento de escolha para a calibração dos examinadores. Entretanto, na impossibilidade de seu uso, recomenda-se a utilização da porcentagem geral de concordância associada ao índice dice, a fim de direcionar e aprimorar os examinadores no exame das lesões cariosas.

Effect of different diagnostic thresholds on dental caries calibration - a 12 month evaluation

OBJECTIVE

To analyze the reproducibility of a calibration trial, at different diagnostic thresholds of dental caries, in a 12-month evaluation.

METHODS

A group of dental examiners (n = 11), who had previous experience in epidemiological surveys, participated in the study. An initial training phase (theoretical and clinical) and five calibration exercises (baseline, 3, 6, 9 and 12 months) were arranged. World Health Organization (WHO) criteria, including the active initial lesions (IL) were used. Six- to 7-year-old children took part in the study. They were selected according to past history and dental caries activity. The data were analyzed at WHO and WHO + IL diagnostic thresholds in accordance with tooth and dental surfaces.

RESULTS

Excellent mean intra- and inter-examiner Kappa values were obtained for both diagnostic thresholds, in accordance with tooth and surface, during the calibration phases. However, the most relevant errors were related to the decayed component and to IL diagnosis.

CONCLUSION

It was possible to use the methodology proposed in this study in epidemiological surveys when examining the mixed dentition, although new strategies to improve training in IL diagnosis and calibration are necessary.

Assessment of different methods for diagnosing dental caries in epidemiological surveys

AIMS

The aims of the study were: (i) to assess different clinical diagnostic methods of dental caries during epidemiological surveys; (ii) to determine which combinations of methods and diagnostic adjuncts show the best performances in epidemiological surveys when compared with examinations performed in a traditional dental setting (standard); (iii) to evaluate the influence of including noncavitated (NC) lesions in dental caries estimation.

METHODS

Forty 12-year-old children were divided into low and moderate caries prevalence groups. The individuals were submitted to 12 epidemiological examinations (in an outdoor setting), which combined three methods (blade, mirror and mirror + CPI (Community Periodontal Index) dental probe) with or without diagnostic adjuncts (previous dental brushing and dental drying). The last examination was performed in a traditional dental setting (standard examination). The unit of measure was the DMFS (decayed, missing and filled surfaces) index according to WHO criteria. The variance analysis, Dunnet's and Tukey's tests were applied.

RESULTS

For the DMFS analysis, the visual/tactile method, with or without diagnostic adjuncts, was the best method for both groups, presenting a performance higher than 90% when compared with the standard examination, except for the examinations without previous dental brushing for the low caries prevalence group. Previous dental brushing was more relevant than dental drying (P = 0.0054). All of the epidemiological examinations underestimated the NC diagnosis even with the association of diagnostic adjuncts when compared with the standard examination.

CONCLUSION

The visual-tactile (for both groups) and the visual (mirror) methods plus dental brushing (for the moderate group) are appropriate for diagnosing cavitated lesions, but not NC lesions.

Influence of diagnostic adjuncts to the measurement of caries prevalence at different caries thresholds

OBJECTIVES

To determine the influence of diagnostic adjuncts (dental brushing and drying) in dental caries diagnosis. To analyse the underestimation levels in epidemiological examinations when compared to traditional dental setting examinations. To evaluate the influence of including noncavitated (NC) carious lesions in the estimation of the disease.

PARTICIPANTS

51, 12-year-old children.

INTERVENTIONS/METHODS

Four epidemiological exams performed in an outdoor setting and one performed in a traditional dental setting (visual-tactile method associated or not with diagnostic adjuncts).

MAIN OUTCOME MEASURES

DMFS (Decayed, Missing and Filled Surfaces) index, according to the WHO criteria.

RESULTS

When compared to exams carried out in a traditional dental setting, the epidemiological examinations showed no significant statistical differences for the DMFS score (p>0.05), presenting underestimation levels lower than 10% (except for the low prevalence caries group in the WHO exam). For the DMFS, previous dental brushing was more relevant than previous dental drying, although drying was the most important resource for NC diagnosis (p<0.05).

CONCLUSION

The visual/tactile method, with or without diagnostic adjuncts, can diagnose cavitated lesions efficiently, but not NC lesions. However, for the low caries prevalence group, the implementation of dental brushing prior to an exam could be suggested.

Comparison of diagnostic methods for dental caries

PURPOSE

The purpose of this study was to compare results of 4 different methods of diagnosing dental caries in 12-year-old children by evaluating their influence on the DMFS index and analyzing the correlation of the radiographic exam with the clinical exam.

METHODS

The tools used were: 1) dental mirror; 2) dental mirror and dental explorer, both performed in an outdoor setting under natural light; 3) dental mirror; 4) dental mirror and dental explorer, both performed in a traditional dental setting under artificial light. The radiographic exam was carried out after the clinical exam.

RESULTS

The dental explorer may be omitted from the clinical exam in epidemiological surveys and in clinical exams performed in dental offices. Methods 3) and 4) performed better in diagnosing dental caries than methods 1) and 2), which underestimated decay.

CONCLUSIONS

In the traditional dental setting, the process of dental cleaning and drying as well as artificial light, improved the diagnosis of dental caries. The radiographic exam used for epidemiological surveys, in relation to method 2), improved the clinical exam by 4%.

Soluble plasma thrombomodulin levels in patients with chronic myeloproliferative disorder

The plasma levels of soluble thrombomodulin (TM) were measured in 44 patients with chronic myeloproliferative disorder, 15 with polycythemia vera (PV), 29 with essential thrombocythemia (ET), and a group of 62 matched healthy controls. The younger patients had significantly lower TM levels (mean: 15.6 +/- 4.8 ng/mL) than the older patients (mean: 28.6 +/- 8.2 ng/mL, p < .001). Moreover, a significant negative correlation between platelet counts and plasma TM levels in healthy persons was noted (r = 0.317, p < .05). The only significant difference we found in plasma TM levels between patients and controls or among patients was between the young patients with ET (mean: 29.0 +/- 19.2 ng/mL) and young healthy controls (mean: 15.6 +/- 4.8 ng/mL). It is possible that younger ET patients with more active platelets are more susceptible to earlier vascular damage. The lack of any significant difference compared with the older patient population supports this hypothesis.

Endothelin-1 and its receptors A and B in human aldosterone-producing adenomas

Endothelin-1 stimulates aldosterone secretion by interacting with specific receptors. Accordingly, we wished to investigate endothelin-1, endothelin-A (ETA) receptor, and endothelin-B (ETB) receptor gene expression, localization, and properties in aldosterone-producing adenomas and in the normal human adrenal cortex. We carried out 125I-endothelin-1 displacement studies with cold endothelin-1, endothelin-3, the specific ETA antagonist BQ-123, and the specific ETB weak agonist sarafotoxin 6 C and coanalyzed data with the nonlinear iterative curve-fitting program LIGAND. We also studied gene expression with reverse transcription-polymerase chain reaction with specific primers for endothelin-1, ETA, and ETB complementary DNA. Normal adrenal cortices from consenting kidney cancer patients (n = 2) and aldosterone-producing adenomas (n = 4) were studied; for the latter, surrounding normal cortex and kidney biopsy tissue served as controls. To further localize the receptor subtypes, tissue sections were studied by autoradiography in the presence and absence of 500 nmol/L BQ-123, 100 nmol/L sarafotoxin 6 C, and 1 mumol/L cold endothelin-1. In all tissues examined, endothelin-1, ETA, and ETB messenger RNAs were easily detected. However, in aldosterone-producing adenomas, both receptors' genes were expressed at a higher level than in the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

In primary aldosteronism the circadian blood pressure rhythm is similar to that in primary hypertension

To investigate whether the 24-hour blood pressure (BP) profile of primary aldosteronism differs from that of primary hypertension, ambulatory BP monitoring was performed in 11 patients with primary aldosteronism (9 with an adrenal adenoma and 2 with idiopathic hyperaldosteronism) and in 11 primary hypertensives, matched for sex (5M,6F), age (mean: 52 vs 49 yrs) and casual BP. We found no difference in 24-hour BP, nocturnal BP fall, BP variability (standard deviation and peaks of pressure) response to postural changes (lying-standing BP) between the two groups (all p values n.s.). Within the patients with primary aldosteronism no correlation was observed between BP, plasma renin activity, blood and urine aldosterone levels, blood and urine K+, and size of the tumour. Thus, at variance with previous reports, these results show that diurnal rhythm of BP and BP variability are similar in primary aldosteronism and primary hypertensives with similar demographic features and causal BP levels. They also show that an orthostatic fall of BP is not a common feature in this disease.

Gene expression, localization, and characterization of endothelin A and B receptors in the human adrenal cortex

Compelling evidence indicates that the endothelium-derived potent vasoconstrictor endothelin-1 (ET-1) stimulates aldosterone secretion by interacting with specific receptors. Although two different ET-1 receptors have been identified and cloned, the receptor subtype involved in mediating aldosterone secretion is still unknown. Accordingly, we wished to investigate whether the genes of ET-1 and of its receptors A and B are expressed in the normal human adrenal cortex. We designed specific primers for ET-1 and the ETA and ETB receptors genes and developed a reverse transcription polymerase chain reaction (RT-PCR) with chemiluminescent quantitation of the cDNA. In addition, we carried out 125I ET-1 displacement studies with cold ET-1, ET-3 and the specific ETA and ETB ligands BQ123 and sarafotoxin 6C. Localization of each receptor subtype was also investigated by autoradiography. Binding experiments were first individually analyzed by Scatchard and Hofstee plot and then coanalyzed by the nonlinear iterative curve fitting program Ligand. Histologically normal adrenal cortex tissue, obtained from kidney cancer patients (n = 7), and an aldosterone-producing adenoma (APA), which is histogenetically derived from the zona glomerulosa (ZG) cells, were studied. Results showed that the ET-1, ETA and ETB mRNA can be detected by RT-PCR in all adrenal cortices as well as in the APA. The best fitting of the 125I ET-1 displacement binding data was consistently provided by a two-site model both in the normal adrenal cortex (F = 22.1, P < 0.0001) and in the APA (F = 18.4, P < 0.0001). In the former the density (Bmax) of the ETA and ETB subtype was 2.6 +/- 0.5 pmol/mg protein (m +/- SEM) and 1.19 +/- 0.6, respectively. The dissociation constant (Kd) of ET-1, ET-3, S6C, and BQ-123 for each receptor subtype resulted to be within the range reported for human tissue for the ETA and ETB receptors. In the APA tissue the Bmax tended to be lower (1.33 and 0.8 pmol/mg protein, for the ETA and ETB, respectively) but the Kd were similar. Autoradiographic studies confirmed the presence of both receptor subtypes on the ZG as well as on APA cells. Thus, the genes of ET-1 and both its receptor subtypes ETA and ETB are actively transcribed in the human adrenal cortex. Furthermore, both receptor subtypes are translated into proteins in ZG and APA cells.

[Genetic basis of arterial hypertension: new findings in molecular research methods]

Arterial hypertension is thought to derive from an interaction between genetic and environmental factors. Primary hypertension is currently deemed to be under complete polygenic control but highly heterogeneous both from the genetic and the pathophysiologic standpoint. In the last few years a widespread application of molecular medicine techniques to epidemiological genetic studies has led to unprecedented progress in unravelling the genetical basis of human hypertension. The current research strategies along with the most recent results in this field are reviewed.

Sequelae of acute hypoglycaemia on 24 hour blood pressure and metabolic parameters in normal and type 1 (insulin-dependent) diabetic individuals

This study was performed to assess possible delayed after-effects of acute hypoglycaemia on blood pressure (BP) and heart rate (HR) over a 24-h period. Eleven insulin-dependent diabetic patients and 11 sex, age, and body mass index matched non-diabetic subjects were studied. Blood pressure was measured using a non-invasive ambulatory blood pressure monitor following acutely induced hypoglycaemia in the morning. No significant differences were observed in 24-h systolic and diastolic BP and HR in either groups, between the day when hypoglycaemia was induced and the day when plasma glucose was kept normal. In diabetic patients, hypoglycaemia induced a temporary but significant fall in mean BP (-7 +/- 1 mmHg vs -2 +/- 2; p < 0.05). Plasma glucose levels were significantly higher in insulin-dependent diabetic patients following hypoglycaemia than in those observed during the reference test. This study demonstrates that acute hypoglycaemia in insulin-dependent diabetic subjects does not cause significant alterations in 24-h BP in either diabetic or normal subjects.

Necrosis of a phaeochromocytoma associated with spontaneous remission of diabetes and hypertension

The diagnosis of phaeochromocytoma is sometimes difficult since its clinical presentation is quite variable. We report a 52-year-old woman who presented with acute diabetes mellitus and severe hypertension, which spontaneously disappeared. MIBG-scintigraphy and urine and plasma catecholamines were normal. At surgery, a largely necrotic phaeochromocytoma was found. Pathological examination demonstrated extensive avascular necrosis, which had occurred spontaneously without any major symptoms.

Imaging of aldosterone-secreting adenomas: a prospective comparison of computed tomography and magnetic resonance imaging in 27 patients with suspected primary aldosteronism

We have compared prospectively the sensitivity, specificity and accuracy of CT and MRI in a series of 27 consecutive patients (age 23-76 yrs, 17 females, 10 males) with clinically suspected primary aldosteronism. We found 13 patients with a unilateral aldosterone-producing adenoma (11 on the left and 2 on the right side), 6 with idiopathic hyper-aldosteronism and 8 with primary hypertension, which in two cases was associated with a nonfunctioning adrenal adenoma. The diagnosis of aldosterone-producing adenoma was confirmed at surgery and pathology in all cases. Idiopathic hyper-aldosteronism was diagnosed on the basis of the results of dexamethasone-suppressed adrenal scintigraphy and/or selective adrenal vein sampling. MRI correctly identified all cases of aldosterone-producing adenoma, but gave false positive results in five cases: one had idiopathic hyper-aldosteronism with bilateral nodular hyperplasia and four primary hypertension, which in two patients was associated with a nonfunctioning adrenal adenoma. Therefore, the sensitivity of MRI was 100%, its specificity 64% and overall diagnostic accuracy 81%. In comparison, CT correctly recognized only eight of the 13 patients with aldosterone-producing adenoma and gave false positive results in three primary hypertensives, including the two patients with a nonfunctioning adrenal adenoma. Therefore, its sensitivity, specificity and accuracy were 62, 77 and 69%, respectively. Based on these results, it could be anticipated that about four of every ten patients with aldosterone-producing adenoma would not be correctly diagnosed by CT.(ABSTRACT TRUNCATED AT 250 WORDS)

A renin-secreting tumour with severe hypertension and cardiovascular disease: a diagnostic and therapeutic challenge

A case of renin-secreting juxtaglomerular cell tumour which presented with a severe hypertensive crisis and did not respond to angiotensin converting enzyme inhibitors but was promptly controlled by intravenous labetalol is reported. The diagnostic difficulties which can be encountered in such cases and the usefulness of the different diagnostic tests, including renal vein renin measurement, are discussed.

Prevalence of extracranial carotid artery lesions at duplex in primary aldosteronism

Renovascular hypertension and high renin hypertension were found to be associated with an excess prevalence of carotid artery atherosclerotic lesions and to a higher risk of stroke, respectively, as compared to low-to-normal renin hypertension. Primary aldosteronism, being characterized by hypertension and a chronically suppressed plasma renin activity, should be accompanied by a low prevalence of carotid artery lesions. To verify this hypothesis we investigated prospectively, by a high resolution duplex ultrasound technique, the prevalence of extracranial carotid artery lesions in a case-controlled study of 34 (22 women and 12 men, aged 22 to 76 years) patients with no history or symptoms of cerebrovascular disease. Primary aldosteronism was diagnosed in 17 patients; 12 had a surgically confirmed unilateral aldosterone-secreting adenoma; and 5 had idiopathic hyperaldosteronism. Each primary aldosteronism patient was individually matched with a control with primary hypertension for sex, race, age, body mass index, casual blood pressure levels, duration of hypertension, smoking, diabetes mellitus, total serum cholesterol, and triglycerides. After the matching, the two groups were similar in terms of demographic features and overall cardiovascular risk profile (all P = NS). However, plasma renin activity and aldosterone levels were significantly lower and higher, respectively, in primary aldosteronism than in primary hypertensive patients. In primary aldosteronism the overall prevalence of carotid artery lesions at duplex was 59%, not significantly different from that (53%) found in primary hypertensives. Thus, at variance with renovascular hypertension, primary aldosteronism is not associated with an excess prevalence of carotid artery lesions.

Excess prevalence of extracranial carotid artery lesions in renovascular hypertension

High renin hypertension has been associated with a higher risk of stroke than low-to-normal renin hypertension. Accordingly, we investigated prospectively the prevalence of the extracranial carotid artery lesions in a case-control study of 70 patients (38 women and 32 men, aged 16 to 77 years) without history or symptoms of cerebrovascular disease. Renovascular hypertension was diagnosed in 35 patients on the basis of the angiographic demonstration of renal artery stenosis and of the favorable outcome after revascularization. It was caused by atherosclerosis in 20 patients and by fibrodysplasia in 15. Each renovascular hypertensive patient was individually matched with a control with primary hypertension for sex, race, age, blood pressure levels, duration of hypertension, smoking, diabetes mellitus, total serum cholesterol, and triglycerides. Carotid arteries were evaluated by a High Resolution Duplex system (Biosound 2000, probe 4 cm, 8 mHz). Our results show that after the matching the two groups were similar in terms of demographic features and overall cardiovascular risk profile (all P = NS). In renovascular hypertensives the prevalence of carotid artery lesions (82.6%) was significantly (P less than .01) higher than in primary hypertensives (42.9%). The higher prevalence of lesions in renovascular hypertension was observed not only in patients with atherosclerosis (100% v 55%, P less than .001), but also in those with fibrodysplasia (57% v 27%, P less than .01). Thus, for the same demographic features and overall cardiovascular risk profile, renovascular hypertension carries a more detrimental effect on the carotid artery than primary hypertension.

[High prevalence of obstructive lesions of the extracranial carotid arteries in reno-vascular hypertension]

Ischemic stroke represents a leading cause of death in patients with renovascular hypertension. In the vast majority it is related to obstructive lesions of the extracranial tracts of the carotid arteries. Since no data were previously available on carotid artery lesions in patients (pts) with renovascular hypertension, a prospective case-control study was undertaken to assess the prevalence of carotid artery lesions in renovascular hypertension. Nineteen pts (10 females and 9 males, age: 26-77 yrs) with a diagnosis of renovascular hypertension based on the presence of uni- or bilateral renal artery stenosis and favourable outcome after either percutaneous transluminal renal angioplasty or surgery, and/or renal vein studies, were evaluated. The cause of renal artery stenosis was atherosclerosis in 12 pts and fibrodysplasia in 7. Each pt was matched with a control pt with primary hypertension for sex, race, age, blood pressure levels, smoking habits and serum cholesterol levels. Carotid artery lesions were assessed using a high resolution echo-Doppler (Duplex) system (Biosound 2000, probe 4 cm, 8 mHz). After the matching, the two groups were almost identical in terms of demographic features and risk profile. In the control group the prevalence of carotid artery lesions was similar to that reported in the literature. On the contrary, a highly significant higher prevalence of carotid artery lesions was observed in the pts with renovascular hypertension (92.1 vs 42.1%, respectively; p less than 0.001). Subgroup analysis showed that this difference was found mainly in pts with atherosclerotic renal artery stenoses.(ABSTRACT TRUNCATED AT 400 WORDS)

[An epidemiological study of psychiatric emergencies at the Biella Department of Emergencies and Admissions in the 5 years of 1983-1987]

The psychiatric intervention procedure at the Emergency and Registration Department (ERD) of Biella Hospital is examined. After a short introduction in which some general data are provided regarding Health Unit no. 47 of Biella and Unit no. 48 of Cossato, the data collected by the ERD psychiatric register are analysed. Data on ERD arrival modalities are reviewed and the type of diagnosis attributed by the psychiatrist to patients examined at the ERD is examined. The various types of responses given by the psychiatrist after consultancy are then presented. The time bands in which the request for psychiatric intervention mainly fall are then noted. The paper closes with remarks on the effectiveness over time of psychiatric intervention at the ERD.

[An examination of the correlations between the general population and the users of the Biella Mental Health Service]

This paper correlates certain general population variables with that of the users of the Biella Mental Health Service. Age, sex, civic status and schooling are considered. Analysis of the data points to certain risk zones. The significance of these correlations is considered.